X $75.00 = # of TFE Applications. Informationn. Event. vendor EXEMPT. Monroe, NC ChristyFord@co. o.union.nc.us. e mail: City: State: Zip:

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1 Union County Public Health Division Environmental Health Section 500 N. Main St. Suite 47 Monroe, NC # of TFE Applications X $75.00 = EVENT ORGANIZER APPLICATION Each special event involving food is unique. Due to the way the rules are written, some events and vendors may be exempt. It is in the best interest of the organizer, sponsor, coordinator, food vendors, and the health of the public that you contact the Union County Environmental Health Department, Fire Marshal, Zoning, etc., prior to any event involving food to determine what will be required. Although the bulk of the requirements detailed in this packet will have to be met by the individual food vendor, the organizer is responsible for ensuring the information includedd in the application is correct. A separate Temporary Food Event Application for eachh vendor must be received by the Union County Health Department, Division of Environmental Health at least 15 days prior to the event. The event coordinator is responsible for submitting all vendor applications for review in the allotted time. No TFE applications will be accepted after this deadline. Individual vendor applications will not be accepted. Itt is the responsibility of each individual vendor to meet all requirements, stated in this packet, before a permit will bee issued. EXEMPT STATUS: Nonprofit organizations, political committees, and other organizations that are exempt from federal income tax, mayy preparee and sell food one time per month, as long as they do not exceed two consecutive days. If you are claiming Exempt Status, please complete the form titled Application for Exempt Temporary Events. In addition, please provide a copy of the Letter of Declaration from the North Carolinaa Department of Revenue or the Internal Revenue Service, or a letter from the candidate or political action committee authorizing you to conduct the event. There is no need to complete the event organizerr or food vendor applicationss unless it is determined that the event or vendors do not qualify for Exempt Status. Temporary Food Establishment (TFE) vendors who sell only non potentially hazardous drinks, such as fresh squeezed lemonade, coffee, tea, etc., are not required to obtain a permit from Environmental Health. TFE vendors who sell only dippedd ice cream, popcorn, candy apples, cotton candy, funnel cakes, soft pretzels andor pre packaged chips orr candy are nott required to obtain a permit from Environmental Health. Questions? Please call Union County Environmental Health at (704) Thank you in advance for your cooperation and good luck with your event. Mail applications to: e mail: Union County Health Environmental Health 500 N. Main Street, Suite 47 Monroe, NC ChristyFord@co o.union.nc.us Organizer Information Organizer Name: Mailing Address: Phone (8am 5pm): ( E Mail: ) After 5pm): ( ) Event Informationn Name of event: Event Address: Dates and hours of operation: Event Organizer Form

2 Admission Charged: YES No Will event last for at least 6 consecutive hours? YES No Maximum Attendance: Will the organizer be supplying water to the food booths? YES If yes, what is the water source? CityPublic Private Well Note: A food grade hose is required for all water connections. Attach a map of the event grounds showing the location for each food booth, toilet facilities, water connections, etc. No Please list ALL participating FOOD VENDOR INFORMATION below. Use additional pages as needed. Name of Booth OwnerOperator Phone NumberE mail General Menu Example Food Booth Jane Doe @ .com Funnel Cakes, blooming onions, sandwiches, hamburgers, and corn on the cob. STATEMENT: I hereby certify that the above information is correct and I fully understand that any deviation from the above without prior permission from Union County Environmental Health may nullify final approval and prevent issuance of permits to participating food vendors. I understand that a pre opening inspection of each food vendor is required and if the food vendor is not in compliance with 15A NCAC 18A.2635 a temporary food establishment permit will not be issued. Print Name Signature Date

3 Union County Environmental Health Division of Union County Health Department 500 N. Main St. Suite 47 Monroe, NC TEMPORARY FOOD EVENT APPLICATION TEMPORARY FOOD EVENT (operates in connection with a fair, carnival, circus, public exhibition or other similar gathering) Your Organization or Booth Name: Event: Event Address: Applicant Information Name: Mailing Address: Phone: ( ) Datestime of operation: Indicate the distance and time for transporting food or beverages to the food service site. Distance: Time: How will the food temperatures be maintained during transportation? What is the source for ice that will be used? Will the booth be connected to water, sewer, electricity (Check all that apply) The food booth will be in a tent, trailer, building, other (describe) Describe equipment to be used for: Cold holding: Cooking: Hot holding: Reheating:

4 Menu (*MENU ITEMS ARE SUBJECT TO APPROVAL AND MAY BE RESTRICTED) PLEASE LIST ALL FOOD TO BE SERVED. INCLUDE HOW YOU PLAN TO KEEP POTENTIALLY HAZARDOUS FOOD HOT (135 F or greater) OR COLD (41 F or less). Food items not listed may result in a delay of issuance or denial of a permit. Please use one row for each food item and include all beverages. Example: Hamburgers FOOD Food Supplier or Source Prepackaged Frozen patties from Sam s Club Prepared and Cooked How? Cooked on grill at the event Cold or Hot Holding Where? Hold hot in a crock pot with beef broth *ATTACH ADDITIONAL SHEETS IF NECESSARY Layout of your Booth Please indicate ALL equipment that you will be using including what will be used to store cold foods and hot foods

5 Temporary Food Establishments (Checklist for Vendors) Have your temporary food establishment cleaned and sanitized prior to visit by an Environmental Health Specialist (EHS). The following checklist must be completed in order to receive a permit: Employee Health Policy must be completed, adhered to, and kept on file or posted. Proper handwashing must be completed after smoking, eating, visiting toilet facilities, before returning to work, and as necessary to prevent contamination No smoking or tobacco use allowed inside Temporary Food Establishment (TFE). A separate handwashing facility with antibacterial soap paper towels. Hair restraints and clean clothing to be worn by each employee in TFE. (Baseball hat, hairnet, etc.) Employees must have access to toilet facilities that are kept clean and in good repair. Sanitizer made with regular unscented bleach mixed with water to make a 50 ppm solution or other approved sanitizer. Containersbottles labeled. A food preparation sink must be provided for washing produce in TFE. DO NOT PREPARE FOOD BEFORE RECEIVING A PERMIT; any food pre prepped will be discarded. Any foods requiring preparation prior to the event must be prepared in a kitchen that has been approved by EHS. Approved & adequate supply of ice. Ice used for drinks should be kept in separate cooler from foods. Ice scoops are required when dispensing ice to customers. All food must be from approved source and receipts andor invoices must be available upon request. Raw meat, poultry, and fish shall be purchased in ready to cook portions. Any variance to this rule must be in writing and approved by EHS. No salads that contain ingredients that have been cooked and cooled (e.g. tuna salad, potato salad, egg salad, etc.) may be served unless commercially prepared. Food prepared at a previous event or potentially hazardous food (timetemperature control for safety food) removed from original packaging shall not be served. Food stored off the ground. Cold foods maintained at 41 F or below at all times. Equipment provided to maintain temperature. Hot foods maintained at 135 F or above at all times after reaching final cook temperature. Equipment provided to maintain temperature. A clean and sanitized food grade hose and backflow protection is required for water connections under pressure. A metal stem food thermometer (for taking food temperatures). Water under pressure and a means of heating water is required (hot water heater, etc.). Three basins of sufficient size to wash, rinse, and sanitize utensils shall be provided. At least one drainboard, table, or counter space shall be provided for air drying. Provide effective measures (such as fans, screens, wall) to keep dust, insects, rodents, animals, and other sources of potential contamination out of the permitted area. Lighting is required for nighttime operations. Open displays of food must be protected from contamination by sneeze guards, or other effective barriers. (Grills, fryers, hot holding areas, ice bins, etc. are examples of such areas) Equipment and utensils cleaned and sanitized before use at temporary event. In the absence of asphalt, concrete, grass, or other surfaces that control dust or mud, carpeting, matting, tarps, or similar nonabsorbent material is required as ground cover. Garbage and refuse shall be collected and stored in garbage containers with properly fitted lids. Waste water must be disposed on in a sanitary sewer or other approved means. Public access restricted to all areas of the food establishment except dining areas. Overhead protection shall be provided (tentcanopy) such that all food, utensils, and equipment are protected. The permits must be posted in a conspicuous place designated by the regulatory authority.

6 All food preparation is to take place in an area that is clean and protected byy an overhead covering. Cooking and serving equipment is to be positioned so that the food is not exposed to the public otherwise shields or sneeze guards must be provided. In the absencee of asphalt, concrete, grass, or other surfaces that control dust or mud carpeting, matting, tarps, or similar nonabsorbent material is required as ground cover. EXAMPLE LAYOUT Handwash Station If a standard sink is not used. 1. Fill a container that has a spout or dispensing valve (e.g. tea urn) with warm water that is at a comfortable temperature for washing your hands. An insulated container will help to maintain the water temperature. The dispensing valve should be able to remain open during the handwashing procedure. 2. Provide a pump dispenser of antimicrobial soap. Hand sanitizers cannot bee substituted for soap but can be used in addition to soap. 3. Provide single use paper towels for drying hands. 4. Provide a bucket or other receptacle for collecting the water as hands are washed. This waste water is to be disposed of in a publicc sewer or septic system. Do NOT pour this water into a storm drain or sidee ditch Ways to Prevent Foodbornee Illnesses 1. Handwashin ng 2. Don t work when you are sick 3. No bare hand contact with Ready-to-Eat food.